CPR is a lifesaving technique that is useful in many emergencies in which a human patient's breathing and/or heartbeat has stopped, including heart attack or near drowning. When the heart stops, the lack of oxygenated blood can cause brain damage in only a few minutes. A person may die within eight to ten minutes. CPR can keep oxygenated blood flowing to the patient's brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.
If a patient is encountered whose breathing and/or heartbeat has stopped, the American Heart Association recommends that CPR be begun with 30 chest compressions. Then, it is recommended that the patient's airway be checked, and the rescuer begin to give rescue breaths. This recommendation applies to adults, children and infants needing CPR, but not newborns.
Before starting CPR, a rescuer should check to determine if the patient is conscious or unconscious. If the patient appears to be unconscious, the rescuer should tap or shake his or her shoulder and ask loudly, “Are you OK?” If the patient doesn't respond and two people are available, one should call 911 or the local emergency number and one should begin CPR. If a rescuer is alone and has immediate access to a telephone, he or she should call 911 before beginning CPR, unless it is believed that the patient has become unresponsive because of suffocation (such as from drowning). If this is the case, CPR should be begun for one minute before the 911 (or local emergency) call is placed. If an automated external defibrillator (“AED”) is available, the American Heart Association recommends that one shock be delivered per the instructions on the device before CPR is begun.
The American Heart Association uses the acronym CAB, for “compressions, airway, breathing” to help people remember the order to perform the steps of CPR. The purpose of “compressions” is to restore blood circulation. The first step is to place the patient on his or her back on a firm surface. Then for an adult patient, the rescuer should kneel next to the patient's neck and shoulders, and place the heel of one hand over the center of the patient's chest, between the nipples. The rescuer should then place his or her other hand on top of the first hand, keeping his/her elbows straight and positioning his/her shoulders directly above the hands on the patient's chest. The rescuer should then use his/her upper body weight to push straight down on (compress) the chest by at least 2 inches (approximately 5 centimeters). Compression should be carried out at a rate of about 100 compressions per minute. If the rescuer hasn't been trained in CPR, the American Heart Association recommends that he/she continue chest compressions without initiating rescue breathing until there are signs of movement or until emergency medical personnel take over. If the rescuer has been trained in CPR, he/she should proceed to checking the airway and initiating rescue breathing.
After a rescuer who has been trained in CPR has performed 30 chest compressions, he/she should open the patient's airway using a head-tilt, chin-lift maneuver. This requires the rescuer to put his/her palm on the patient's forehead and gently tilt the patient's head back. Then with the other hand, the rescuer should gently lift the patient's chin forward to open the airway. The rescuer should then check for normal breathing, taking no more than 5-10 seconds to do so. The rescuer should look for chest motion, listen for normal breath sounds, and feel for the patient's breath on the rescuer's cheek or ear. Gasping by the patient is not considered to be normal breathing. If the patient isn't breathing normally, mouth-to-mouth breathing for the patient should be begun.
Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened. With the airway open (using the head-tilt, chin-lift maneuver), the rescuer should pinch the nostrils of the patient shut for mouth-to-mouth breathing and cover the patient's mouth with his/her own making a seal. The rescuer should give a first rescue breath, lasting about one second, and then watch to see if the patient's chest rises. If it does rise, the rescuer can proceed with a second breath. If the patient's chest doesn't rise, the rescuer should repeat the head-tilt, chin-lift maneuver before giving the second breath. Thirty chest compressions followed by two rescue breaths is considered one CPR cycle. If the patient has not responded after five cycles (about two minutes) and an AED is available, it should be applied pursuant to the directions and prompts provided by the device. The rescuer should administer one shock, then resume CPR, starting with chest compressions, for two more minutes before administering a second shock. The rescuer should continue CPR until there are signs of movement or until emergency medical personnel arrive.
The procedure for giving CPR to a child between the ages of one and eight is essentially the same as that for an adult. However, if the rescuer is alone, he/she should perform five cycles of compressions and breaths on the child, taking about two minutes, before calling 911 or using an AED. The rescuer should only use one hand to perform chest compressions, and he/she should breathe more gently. The same compression-breath rate should be used as is used for adults, 30 compressions followed by two breaths comprising one cycle. Following the two breaths, the rescuer should immediately begin the next cycle of compressions and breaths. After five cycles (about two minutes) of CPR, if there is no response and an AED is available, it should be applied pursuant to the directions and prompts provided by the device. The rescuer should use pediatric defibrillator pads, if available, for children ages one through eight. If pediatric pads aren't available, adult pads may be used. After one shock has been administered, CPR should be resumed, starting with chest compressions, for two more minutes before administering a second shock. CPR should be continued until the child moves or help arrives.
For infants (i.e., children less than one year old), the rescuer should first stroke the baby and watch for a response, such as movement. The baby should not be shaken. Since most cardiac arrests in babies occur from lack of oxygen such as from drowning or choking, the rescuer should look for an airway obstruction, or perform first aid for choking. If no obstruction is found, CPR should be begun. If the rescuer is alone, CPR should be conducted for five cycles, about two minutes, before calling 911 or a local emergency number. The baby should be placed on his or her back on a firm, flat surface, such as a table or floor. Imagining a transverse line drawn between the baby's nipples, the rescuer should place two fingers of one hand just below this imaginary line, in the center of the chest, and gently compress the chest about 1.5 inches (about 4 centimeters). The rescuer should continue chest compressions at a rate of 100 compressions per minute. After 30 compressions, the rescuer should gently tip the baby's head back by lifting the chin with one hand and pushing down on the forehead with the other hand. Within no more than about 10 seconds, the rescuer should put his/her ear near the baby's mouth and check for breathing. The rescuer should look for chest motion, listen for breath sounds, and feel for breath on his/her cheek and/or ear. If breathing is not detected, the rescuer should cover the baby's mouth and nose with his/her mouth and using the strength of his/her cheeks, deliver a gentle puff of air (instead of a deep breath from his/her lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. If the baby's chest rises, a second rescue breath may be given. If the baby's chest does not rise, the head-tilt, chin-lift maneuver should be repeated before the second breath is given. If the baby's chest still doesn't rise, the rescuer should examine the baby's mouth to make sure that no foreign material is inside. If an object is seen, the mouth should be swept by the rescuer with his/her finger. If the airway seems blocked, first aid for a choking baby should be performed. Two breaths should be given after every 30 chest compressions, and CPR should be continued until the baby responds or until medical personnel arrive.
As can be appreciated, the instructions for CPR are somewhat complicated, and they may be hard for a rescuer to remember in an emergency situation. In addition, some potential rescuers are reluctant to make direct mouth-to-mouth contact with a stranger. It would be desirable if an inexpensive device could be provided that would make it easy for a rescuer to perform CPR.